Location: Idlewild Ave, Tampa, FL 33634
Department: Operations - Payment Integrity
Reports to: Sr. Manager, Coding Integrity
Manage activities within the Claims Coding/Pre-Pay department. Build strong relationships with key functional areas. Responsible for all performance results of the Department.
- Manages the business analysis, quality testing, implementation and production support efforts for all WellCare claims editing projects.
- Responsible for all testing deliverables, ensuring business requirements documentation and test plans are designed to meet the business needs.
- Responsible for the performance management processes for direct reports including coaching, counseling, providing feedback, career planning, goal setting, and performance assessment.
- Manages process improvement initiatives, seeking root cause and developing appropriate corrective action.
- Establishes objectives, goals and performance measures for the function being managed.
- Coordinates activities to ensure key deliverables are met and resolves conflicting demands.
- Serves as primary contact for complex coding issues.
- Assists in developing short range plans for overall departmental activities.
- Oversees the implementation of programs and strategies.
- Acts in liaison capacity with other areas and business units.
- May make recommendations on matters of policy and approve changes in area of expertise.
- Performs other duties as assigned.
- Required: High School diploma or GED
- Preferred: Bachelor's Degree in a related field
- Required: 5 years of experience in analytics; including claims processing/coding and/or testing
- Required: 2 years of experience in a management, supervisory or lead role
- Required: 2 years of experience in project lifecycles
- Preferred: 1 years of experience in Healthcare
- Demonstrated interpersonal/verbal communication skills
- Demonstrated analytical skills
- Demonstrated written communication skills
- Ability to drive multiple projects
- Ability to work in a fast paced environment with changing priorities
- Demonstrated organizational skills
- Demonstrated project management skills
- Microsoft Access
- Microsoft PowerPoint
- Microsoft Excel
- Microsoft Outlook
- Microsoft Visio
- Knowledge of one or more of the following: SQL, Xcelys, CES, iHT
- Medical Billing and Coding
- Claim reimbursement methodologies